NHS Digital consults the public on data and tech

Recently, NHS Digital has published two public consultations that are of broad public interest and deserving of comprehensive feedback. They are looking to define principles and standards for the use of NHS technology and data.

I’ve summarised and linked to them below in the hope that you will take a bit of time to take part.

Continue reading “NHS Digital consults the public on data and tech”

My 2018 event schedule

I only realised in hindsight that I attended a number of tech events, meetups, training, hackathons etc. during 2017.

To attempt to be a bit more organised, and in case it’s of interest to others, I’m going to keep a live list of my planned events for 2018 here. Give me a shout if you’re interested in any of them and would like to know more!

January

May

June

September

October

  • TBC – MindTheProduct Conference, London

November

The Zen of Interoperability

I was having a discussion with a colleague this week about architectural options for some specific interoperability use cases we are tackling.

The conversation touched on implementation choice – how much flexibility should there be in how to approach specific interoperability use cases within the NHS?

I’ve thought about this quite a bit, and struggled with the complexity that “many ways to do the same thing” can introduce. I naturally found myself quoting PEP 20 — The Zen of Python | Python.org.

Specifically:

There should be one — and preferably only one — obvious way to do it.

Could this be a reasonable principle for us to take with NHS interoperability?

I wonder if there is a place for “The Zen of NHS Interoperability” – to define some guiding principles for all of us working hard to make interoperability useful for the NHS.

Here is a slightly tongue-in-cheek attempt at a “Zen of NHS Interoperability” 🙂

The Zen of Interoperability

Elegant is better than messy.
Explicit is better than implicit.
Simple is better than complex.
Complex is better than complicated.
Open is better than controlled.
But controlled is better than proprietary.
Readability counts.
Special cases aren't special enough to break the rules.
Although practicality beats purity.
Errors should never pass silently.
Unless explicitly silenced.
In the face of ambiguity, refuse the temptation to guess.
There should be one-- and preferably only one --obvious way to do it.
Although that way may not be obvious at first unless you designed it.
Now is better than never.
Although never is often better than *right* now.
If the implementation is hard to explain, it's a bad idea.
If the implementation is easy to explain, it may be a good idea.
Clear Standards are one honking great idea -- let's have more of those!

What are ‘dispositions’ in Urgent Care?

The majority of the content in this post was provided by a colleague.

In Urgent & Emergency Care, dispositions play a key part in helping us to categorise patients and ensure they get the right response for their clinical need.

‘Dispositions’ are defined here: http://medical-dictionary.thefreedictionary.com/disposition.

It is the third definition we’re interested in here:

3. the plan for continuing health care of a patient following discharge from a given health care facility.

My version of this, with the added context of how we use dispositions in NHS urgent & emergency care is:

A disposition packages the perceived clinical need of a patient in the form of a skill set and a time frame.

e.g. “Speak to a clinician | within 2 hours”

We allocate dispositions using information / input data from the patient and our clinical expertise, and are there to help consistently communicate a point-in-time assessment of a patient’s clinical need in terms of what needs to happen next; they are really only ever recommendations.

Although dispositions are essentially recommendations, some scenarios may have pre-defined dispositions that are considered appropriate.

For example – specific clinical conditions might require a disposition that denotes a response by an ambulance, or Key Performance Indicators (KPIs) such as National Quality Requirements (NQRs) might define a maximum amount of time within which a patient should receive a call back from a General Practitioner (GP).

The decision-making process taken to reach a recommended disposition (skillset and timeframe) will vary between entities too. Different organisations, regions, even clinical IT systems may use different reasoning dependent on specific external factors.

For example – a local region may have recently experienced a high number of clinical incidents with unwell children, and therefore decide that all children are seen by a specialist paediatric service, regardless of their presenting features.

E.g. Disposition of “See paediatric specialist | within 2 hours”

This is still a disposition representing a clinical recommendation – i.e. the recommendation that a child be seen within 2 hours by a paediatric specialist – however the decision on which disposition is appropriate was affected by different factors.

In all situations disposition are based on a combination of expert opinion, relevant evidence, and situational factors and therefore they are always subject to change and re-evaluation.

How are dispositions used?

Once a perceived skillset and timeframe have been “packaged” into a disposition, the response to the patient’s identified need will, and can, vary depending on the availability of services locally, the risk appetite of the responsible organisations or individuals, and the prioritisation within services that are available.

How does this relate to prioritisation?

Prioritisation is the next step and can only ever be relative.

A “package” of information has led to the disposition but other factors will decide which of the patients assigned a similar disposition require priority.

More external factors come into play here, such as the age of the patient, their specific condition, and any co-morbidities they may have.

Again, it is ultimately a matter of expert opinion as to which factors have the greatest weighting when deciding priority (although as we do more with data this is likely to be come more evidence-based and less dependent on pure expert opinion).

All the time expert opinion is a significant part of the decision-making process there will be conflict between different expert perspectives and belief systems.